The end of pathology as we know it

[exPCM]

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See link:
http://www.kaisernetwork.org/DAILY_REPORTS/rep_index.cfm?DR_ID=52221

Kaiser Daily Health Policy Report

Medicare | CMS To Launch Three-Year Medicare Demonstration Program That Bundles Payments for Physician, Hospital Services
[May 19, 2008]
CMS on Friday announced plans to launch a three-year Medicare pilot project in 2009 that will test a bundled-payment system in which physicians and hospitals are paid a single amount for all services associated with surgical procedures, CQ HealthBeat reports. CMS currently pays hospitals a pre-set amount for services, but those payments do not include physician services. Under the pilot program, providers would receive a single payment for Medicare Part A, which covers hospital services, and Medicare Part B, which covers physician services. CMS in a statement said, "The physicians who care for the patient during the stay are paid separately under the Medicare Physician Fee Schedule for each service they perform," adding, "The separate payment systems can lead to conflicting incentives that may affect decisions about what care will be provided."

The program will be launched in as many as 15 markets in four states -- Colorado, New Mexico, Oklahoma and Texas -- beginning Jan. 1, 2009, and will involve 28 cardiac and nine orthopedic inpatient surgical services. A CMS spokesperson said the four states were chosen because Medicare administrative contractors there were prepared to participate in the program starting Jan. 1, 2009. CMS also aims to publicly release cost and quality information about the medical services to determine whether such data draw more beneficiaries and physician referrals to the facilities involved.

CMS acting Administrator Kerry Weems said, "CMS expects to demonstrate how to not only better coordinate inpatient care, but to also achieve savings in the delivery of that care that can ultimately be shared between providers."

James Bentley, senior vice president for policy planning at the American Hospital Association, said the pilot program should be a good experiment to show how well physicians and hospitals cooperate, but he added, "We need to find out if there are multiple models that work" (Reichard, CQ HealthBeat, 5/16).

Once this process is expanded to include all surgical procedures and not just orthopedic and cardiac surgery procedures, then IMHO hospital based pathologists will be toast. The hospital based pathologists already have trouble getting Part A compensation from the hospitals and I do think they will be any more successful in getting Part B compensation from the hospitals.

 

[Path or bust]

See link:
http://www.kaisernetwork.org/DAILY_REPORTS/rep_index.cfm?DR_ID=52221

Kaiser Daily Health Policy Report

Medicare | CMS To Launch Three-Year Medicare Demonstration Program That Bundles Payments for Physician, Hospital Services
[May 19, 2008]
CMS on Friday announced plans to launch a three-year Medicare pilot project in 2009 that will test a bundled-payment system in which physicians and hospitals are paid a single amount for all services associated with surgical procedures, CQ HealthBeat reports. CMS currently pays hospitals a pre-set amount for services, but those payments do not include physician services. Under the pilot program, providers would receive a single payment for Medicare Part A, which covers hospital services, and Medicare Part B, which covers physician services. CMS in a statement said, "The physicians who care for the patient during the stay are paid separately under the Medicare Physician Fee Schedule for each service they perform," adding, "The separate payment systems can lead to conflicting incentives that may affect decisions about what care will be provided."

The program will be launched in as many as 15 markets in four states -- Colorado, New Mexico, Oklahoma and Texas -- beginning Jan. 1, 2009, and will involve 28 cardiac and nine orthopedic inpatient surgical services. A CMS spokesperson said the four states were chosen because Medicare administrative contractors there were prepared to participate in the program starting Jan. 1, 2009. CMS also aims to publicly release cost and quality information about the medical services to determine whether such data draw more beneficiaries and physician referrals to the facilities involved.

CMS acting Administrator Kerry Weems said, "CMS expects to demonstrate how to not only better coordinate inpatient care, but to also achieve savings in the delivery of that care that can ultimately be shared between providers."

James Bentley, senior vice president for policy planning at the American Hospital Association, said the pilot program should be a good experiment to show how well physicians and hospitals cooperate, but he added, "We need to find out if there are multiple models that work" (Reichard, CQ HealthBeat, 5/16).

Once this process is expanded to include all surgical procedures and not just orthopedic and cardiac surgery procedures, then IMHO hospital based pathologists will be toast. The hospital based pathologists already have trouble getting Part A compensation from the hospitals and I do think they will be any more successful in getting Part B compensation from the hospitals.

1. This is a demonstration program, there is nothing final about it.

2. I don't see how pathologists specifically are "toast"

3. I don't see how pathology is the only field that will be affected when in actuality this targets surgical specialties more.

 

[Path or bust]

I always find the "sky is falling" mentality kind of funny. If you visit every forum on SDN you'll find AT LEAST one thread in each on that very topic. Hmmmm....why is that? 😕

Physicians are still one of the most highly reimbursed people out there. But you still get statements such as "we are toast", "this is the end of us". I just find it curious that these same intelligent individuals don't really value their knowledge and contribution to patient care.

 

[exPCM]

1. This is a demonstration program, there is nothing final about it.

2. I don't see how pathologists specifically are "toast"

3. I don't see how pathology is the only field that will be affected when in actuality this targets surgical specialties more.

1. This will be expanded rapidly to cut costs. You only have to look at the track record of CMS to figure that out. It will also come into play immediately for pathologists in 4 states beginning on 1/1/2009.

2. You need to figure this out for yourself.

3. I did not say that pathology will be the only field affected (surgeons, anesthesiologists, radiologists will all be affected). It will be interesting to see pathologists trying to get the hospital to reimburse them for the hip that was grossed/signed out etc.

 

[exPCM]

Just look at the physician professional reimbursement for 88305 for instance.

 

[Path or bust]

Just look at the physician professional reimbursement for 88305 for instance.

Yes, is this not the same code that has gotten an overall 8.1% increase in the last few years? (the most commonly billed code in anatomical pathology)

Things still look pretty bright in pathology compared to our colleagues in other fields.



http://www.g2reports.com/issues/DTTR/2007_1/1610952-1.html
[FONT=Verdana, Arial, Helvetica, sans-serif]In 2005, Medicare cut reimbursement for flow cytometry procedures by 40% to 50%. However, pathologists and laboratories received an 8.7% increase in the reimbursement for CPT 88305, the most commonly billed anatomic pathology code.


.

 

[Path or bust]

2. You need to figure this out for yourself.

.

Wow that's super. Thanks for going outside the box on that one. 😉


I believe the point is that you state, "THIS IS THE END OF PATHOLOGY", but these claims are totally unsubstantiated and only serve to make people who don't really know the facts, freak out!

Believe it or not, CMS does not have a vendetta against pathology.

EDIT:

Just wanted to add that I don't really have a "rosy" picture of medicine. I know economics and the name of the game right now is to cut costs wherever possible. But pathology is certainly not at the forefront of this nor does it take all the hit. There will be cuts but it will not devastate the field or bring its end. These kind of ideas (when one is solely concerned about their own livelihood) , in my opinion, keeps us from moving forward in the sense that "attending physicians" don't see a future or even value what they do.

 

[DrBloodmoney]

"CMS expects to demonstrate how to not only better coordinate inpatient care, but to also achieve savings in the delivery of that care that can ultimately be shared between providers."

WTF does that mean?

Are they just going to throw the payment out and let us fight over it?

 

[yaah]

The only fields that are going to be immune from all of this are cosmetic and self-pay fields. And since no one wants to pay for anything health care related anyway, even those are not going to be immune.

I dunno what's going to happen. Health care is going to continue to grow but payments are going to continue to decline. For now, this gap is being made up by people working harder and longer hours and improving efficiency. But that can only take things so far. At some point you hit a wall and then compensation will take a hit. Thus, compensation is going to be an issue for everyone in the medical field with a few exceptions

1) Administrators
2) "Efficiency" experts
3) People who do botox injections or breast implants.

Look what has happened to the rest of medicine - IM used to be the field where the best and brightest went. Now they flock to subspecialties or derm and radiology as payment and reimbursement for IM went down. Right now radiology is well compensated, but why does everyone assume that will continue? Are they really going to close other profit loopholes while leaving open the MRI profit loophole? I doubt it.

People are always going to need their biopsies read. And they are going to want "the best" person to read them. People don't know what pathologists do but when they get a serious illness that depends on biopsy interpretation they figure it out pretty quickly. Pathology isn't going anywhere. It is going to get squeezed like every other field.

 

[exPCM]

Yes, is this not the same code that has gotten an overall 8.1% increase in the last few years? (the most commonly billed code in anatomical pathology)

Things still look pretty bright in pathology compared to our colleagues in other fields.



http://www.g2reports.com/issues/DTTR/2007_1/1610952-1.html
[FONT=Verdana, Arial, Helvetica, sans-serif]In 2005, Medicare cut reimbursement for flow cytometry procedures by 40% to 50%. However, pathologists and laboratories received an 8.7% increase in the reimbursement for CPT 88305, the most commonly billed anatomic pathology code.


.

Yes, I am sure you will be able to extract excellent reimbursement from hospital administrators for your Part A and Part B pathology work when you become a pathologist in the future.

Yes, maybe one day in pathology you will make as much as many firefighters or policeman. See link:
http://www.sfgate.com/webdb/vallejo/?appSession=2777657367575

Yes, I am sure CMS loves pathologists:
From 1992 through 2006, Medicare reimbursement for the professional (pathologist) component of CPT 88305 has shown a steady decline, though it rose slightly from 1998 through 2001. In 1992 the professional reimbursement from Medicare was $63, having fallen to $42 in 2005 and 2006. The professional (pathologist) component only increased slightly (1.5%) from $41.44 in 2004 to $42.07 in 2005. It is amazing to me how many med students think they know more than practicing pathologists. I will sign off on the 88305 reimbursement for now as I have no intention of writing/posting a "Pathology Billing For Dummies" treatise

 

[exPCM]

Are they just going to throw the payment out and let us fight over it?

YES

They already do this for Part A reimbursement and now are expanding it to Part B reimbursement.

 

[exPCM]

I believe the point is that you state, "THIS IS THE END OF PATHOLOGY", but these claims are totally unsubstantiated and only serve to make people who don't really know the facts, freak out!

I posted that IMHO this is the end of pathology as we know it (not THIS IS THE END OF PATHOLOGY) and that hospital-based pathologists will be toast. I am sure you are aware that many pathologists do not work in hospitals. I generally try to include facts and links. I do not see any posts from you which cite any sources other than the source of the image I provided and your own opinion.

 

[Matte Kudesai]

The only fields that are going to be immune from all of this are cosmetic and self-pay fields. And since no one wants to pay for anything health care related anyway, even those are not going to be immune.

I dunno what's going to happen. Health care is going to continue to grow but payments are going to continue to decline. For now, this gap is being made up by people working harder and longer hours and improving efficiency. But that can only take things so far. At some point you hit a wall and then compensation will take a hit. Thus, compensation is going to be an issue for everyone in the medical field with a few exceptions

1) Administrators
2) "Efficiency" experts
3) People who do botox injections or breast implants.

Look what has happened to the rest of medicine - IM used to be the field where the best and brightest went. Now they flock to subspecialties or derm and radiology as payment and reimbursement for IM went down. Right now radiology is well compensated, but why does everyone assume that will continue? Are they really going to close other profit loopholes while leaving open the MRI profit loophole? I doubt it.

People are always going to need their biopsies read. And they are going to want "the best" person to read them. People don't know what pathologists do but when they get a serious illness that depends on biopsy interpretation they figure it out pretty quickly. Pathology isn't going anywhere. It is going to get squeezed like every other field.

UNIONIZE NOW MAN.....😉

or lets try and figure out sexy new ways to generate cash that has nothing to do with reimbursement.

 

[docbiohazard]

Turning and turning in the widening gyre
The falcon cannot hear the falconer;
Things fall apart; the centre cannot hold;
Mere anarchy is loosed upon the world,
The blood-dimmed tide is loosed, and everywhere
The ceremony of innocence is drowned;
The best lack all conviction, while the worst
Are full of passionate intensity.

Surely some revelation is at hand;
Surely the Second Coming is at hand.
The Second Coming! Hardly are those words out
When a vast image out of Spiritus Mundi
Troubles my sight: somewhere in sands of the desert
A shape with lion body and the head of a man,
A gaze blank and pitiless as the sun,
Is moving its slow thighs, while all about it
Reel shadows of the indignant desert birds.
The darkness drops again; but now I know
That twenty centuries of stony sleep
Were vexed to nightmare by a rocking cradle,
And what rough beast, its hour come round at last,
Slouches towards Bethlehem to be born?"

-William Butler Yeats

The phrase "Evolve or die" comes to mind...

DBH

 

[Dermbound00]

If you wanted to make money, you should have chosen another speciality especially considering physicians do not do an adequate job of sticking together and fighting, like lawyers for instance do.
Gas prices are high, food prices are high, healthcare costs are going up but reimbursement is going down, student loan companies who lent out thousands in loans are now attempting to make residents start paying them back during post-graduate training. All this with the potential of a Deomcrat taking office and >50% of your salary will be going to taxes and repayment of student loans.
Skip all fellowships (the exception being Derm of course 😛) and move into a rural area and make all you can while it lasts. Drive a Prius, rent a modest home, and do not procreate.

 

[Path or bust]

If you wanted to make money, you should have chosen another speciality especially considering physicians do not do an adequate job of sticking together and fighting, like lawyers for instance do.
Gas prices are high, food prices are high, healthcare costs are going up but reimbursement is going down, student loan companies who lent out thousands in loans are now attempting to make residents start paying them back during post-graduate training. All this with the potential of a Deomcrat taking office and >50% of your salary will be going to taxes and repayment of student loans.
Skip all fellowships (the exception being Derm of course 😛) and move into a rural area and make all you can while it lasts. Drive a Prius, rent a modest home, and do not procreate.

finally, someone posts some sense on here 😀

 

[Path or bust]

I posted that IMHO this is the end of pathology as we know it (not THIS IS THE END OF PATHOLOGY) and that hospital-based pathologists will be toast. I am sure you are aware that many pathologists do not work in hospitals. I generally try to include facts and links. I do not see any posts from you which cite any sources other than the source of the image I provided and your own opinion.

where do I begin

1. First, this is a TRIAL STUDY, nothing has been placed into effect yet you are making wild, unmerited predictions.

2. I still think you're comments are extremely exaggerated based on information that has been out for years. We all know that pathology is being squeezed. What's new?

3. I posted the source of the image because you conveniently forgot to include the positive facts mentioned on that same paper.🙄

 

[Path or bust]

People are always going to need their biopsies read. And they are going to want "the best" person to read them. People don't know what pathologists do but when they get a serious illness that depends on biopsy interpretation they figure it out pretty quickly. Pathology isn't going anywhere. It is going to get squeezed like every other field.

Excellent point. Whether or not reimbursement goes down does not spell a certain end for pathology (ahmmm, "as we know it"). The truth is that Pathology has a prominent and vital role in medicine and monetary compensation does not dictate how "burned" or "toasted" we may be. 😉

 

[exPCM]

where do I begin

1. First, this is a TRIAL STUDY, nothing has been placed into effect yet you are making wild, unmerited predictions.

2. I still think you're comments are extremely exaggerated based on information that has been out for years. We all know that pathology is being squeezed. What's new?

3. I posted the source of the image because you conveniently forgot to include the positive facts mentioned on that same paper.🙄

The only conclusion I can come to is that you don't know the difference between global reimbursement, technical component reimbursement, and professional component reimbursement in pathology. Look at the graph - Do you call $63 in 1992 vs. $42 in 2006 a positive trend? Why don't you show some real pathologists the details of the CMS program and ask them what they think about it rather than speaking off the top of your head?

 

[Path or bust]

The only conclusion I can come to is that you don't know the difference between global reimbursement, technical component reimbursement, and professional component reimbursement in pathology. Look at the graph - Do you call $63 in 1992 vs. $42 in 2006 a positive trend? Why don't you show some real pathologists the details of the CMS program and ask them what they think about it rather than speaking off the top of your head?

I think because you are not making your point you are resorting to personal attacks, but it doesn't really add anything to your side. There is a term for exactly this, it is an ad hominem. The quote that I made came DIRECTLY from the article you cited. If you are saying that the quote is misinformed/wrong then I question your sources and your interpretation of "reimbursement".

Again for your benefit, here is the link and the citation of your source. 🙄

****you seem to want to have the benefit of posting some information about the article but ignoring other stuff, even going so far as to saying that "I don't understand" and that you will not write something "for dummies" so I can understand. Buddy, you obviously don't know how to have a civilized conversation.


http://www.g2reports.com/issues/DTTR...1610952-1.html
[FONT=Verdana, Arial, Helvetica, sans-serif]In 2005, Medicare cut reimbursement for flow cytometry procedures by 40% to 50%. However, pathologists and laboratories received an 8.7% increase in the reimbursement for CPT 88305, the most commonly billed anatomic pathology code. The global reimbursement level for 88305 in 2005 (and 2006) is $103.46, up from $95.21 in 2004. The majority of this increase came via the technical (laboratory) component, which increased by 14.2% from $53.77 in 2004 to $61.39 in 2005. The professional (pathologist) component only increased slightly (1.5%) from $41.44 in 2004 to $42.07 in 2005.

Overall this has accounted for an 8.1% increase in CPT 88305 reimbursement..[FONT=Verdana, Arial, Helvetica, sans-serif]

I am sure it really takes a "practicing pathologist" to learn how to read, something a mere med student would know nothing of. 😉


Remember you are in the position to have to substantiate the statements that you made, not I. You have been doing exactly what you accuse me of, "speaking off the top of [your] head".
.

 

[Path or bust]

Why don't you show some real pathologists the details of the CMS program and ask them what they think about it rather than speaking off the top of your head?

I didn't realize that it took a "real pathologist" to understand economics 101. It seems that I've been the only one quoting facts and figures and you are simply trying to use your title to bring across your point, which you haven't by the way.

 

[exPCM]

I think because you are not making your point you are resorting to personal attacks, but it doesn't really add anything to your side. The quote that I made came DIRECTLY from the article you cited. If you are saying that the quote is misinformed/wrong then I question your sources and your interpretation of "reimbursement".

Again for your benefit, here is the link and the citation of your source. 🙄


http://www.g2reports.com/issues/DTTR...1610952-1.html
[FONT=Verdana, Arial, Helvetica, sans-serif]In 2005, Medicare cut reimbursement for flow cytometry procedures by 40% to 50%. However, pathologists and laboratories received an 8.7% increase in the reimbursement for CPT 88305, the most commonly billed anatomic pathology code.


I am sure it really takes a "practicing pathologist" to learn how to read, something a mere med student would know nothing of. 😉.

Unfortunately you need to learn what you don't know. Here are direct quote too form that same source:


Can you in your infinite wisdom explain how an 8.7% increase in global billing only translated to a 1.5% increase in professional reimbursement to pathologists.

 

[exPCM]

I think because you are not making your point you are resorting to personal attacks, but it doesn't really add anything to your side. The quote that I made came DIRECTLY from the article you cited. If you are saying that the quote is misinformed/wrong then I question your sources and your interpretation of "reimbursement".

Again for your benefit, here is the link and the citation of your source. 🙄


http://www.g2reports.com/issues/DTTR...1610952-1.html
[FONT=Verdana, Arial, Helvetica, sans-serif]In 2005, Medicare cut reimbursement for flow cytometry procedures by 40% to 50%. However, pathologists and laboratories received an 8.7% increase in the reimbursement for CPT 88305, the most commonly billed anatomic pathology code.


I am sure it really takes a "practicing pathologist" to learn how to read, something a mere med student would know nothing of. 😉.

Unfortunately you need to learn what you don't know. Here are other direct quotes from that same source:
From 1992 through 2006, Medicare reimbursement for the professional (pathologist) component of CPT 88305 has shown a steady decline, though it rose slightly from 1998 through 2001. In 1992 the professional reimbursement from Medicare was $63, having fallen to $42 in 2005 and 2006. In 2005, Medicare cut reimbursement for flow cytometry procedures by 40% to 50%. However, pathologists and laboratories received an 8.7% increase in the reimbursement for CPT 88305, the most commonly billed anatomic pathology code. The global reimbursement level for 88305 in 2005 (and 2006) is $103.46, up from $95.21 in 2004. The majority of this increase came via the technical (laboratory) component, which increased by 14.2% from $53.77 in 2004 to $61.39 in 2005. The professional (pathologist) component only increased slightly (1.5%) from $41.44 in 2004 to $42.07 in 2005. Overall this has accounted for an 8.1% increase in CPT 88305 reimbursement.




Can you in your infinite wisdom explain how an 8.7% increase in global billing only translated to a 1.5% increase in professional reimbursement to pathologists?

 

[Path or bust]

Unfortunately you need to learn what you don't know. Here are other direct quotes from that same source:
From 1992 through 2006, Medicare reimbursement for the professional (pathologist) component of CPT 88305 has shown a steady decline, though it rose slightly from 1998 through 2001. In 1992 the professional reimbursement from Medicare was $63, having fallen to $42 in 2005 and 2006. In 2005, Medicare cut reimbursement for flow cytometry procedures by 40% to 50%. However, pathologists and laboratories received an 8.7% increase in the reimbursement for CPT 88305, the most commonly billed anatomic pathology code. The global reimbursement level for 88305 in 2005 (and 2006) is $103.46, up from $95.21 in 2004. The majority of this increase came via the technical (laboratory) component, which increased by 14.2% from $53.77 in 2004 to $61.39 in 2005. The professional (pathologist) component only increased slightly (1.5%) from $41.44 in 2004 to $42.07 in 2005. Overall this has accounted for an 8.1% increase in CPT 88305 reimbursement.




Can you in your infinite wisdom explain how an 8.7% increase in global billing only translated to a 1.5% increase in professional reimbursement to pathologists?

Well, Doctor, In my infinite wisdom I continued to read the entire article.

While you are concentrating on professional reimbursement alone, I am not. If you continue to read you will realize that professional component INCREASED 1.5% (this is not a decrease like you say above). The majority of the reimbursement for the 88305 code came from the technical laboratory reimbursement of 14.2%

Yet in my infinite inexperience as a mere medstudent I can't for the life of me figure out how pathology is "toast". 😕

 

[exPCM]

Well, Doctor, In my infinite wisdom I continued to ready the entire article.

While you are concentrating on professional reimbursement alone, I am not. If you continue to read you will realize that professional component INCREASED 1.5% (this is not a decrease like you say above). The majority of the reimbursement for the 88305 code came from the technical laboratory reimbursement of 14.2%

Yet in my infinite inexperience as a mere medstudent I can't for the life of me figure out how pathology is "toast". 😕

Teach me oh great one.

From $63 in 1992 to $42 in 2006 looks like a decrease to me and I will continue to say so. Of course you are a great entrepeneur and you will most assuredly buy the hospital's laboratory at the hospital at which you work so that you can then bill and collect for the technical component instead of the hospital. Of course out of that technical reimbursement you will purchase and maintain your tissue processors and pay your histotechs and buy your supplies and cassettes and slides, etc. Unless of course you plan to do all the embedding and cutting yourself and will not have any histotechs at your lab.

 

[Nilf]

Center for Medicare and Medicaid Services announced pilot programs which will bundled payments for clinicians and hospital services.

http://www.kaisernetwork.org/DAILY_REPORTS/rep_index.cfm?DR_ID=52221

What does it mean in plain English?

The program will test a bundled-payment system in which physicians and hospitals are paid a single amount for all services associated with surgical procedures. In other words, CMS will throw the hospitals a preset amount of money per 'service', and the doctors and the hospital administrators will duke it out who gets paid and how much.

Why should you care?

This is the attempt of the government to contain the costs, and you, the future physicians will bear the brunt of these cost-savings measures. This program is only beginning. Many more pilot programs will follow until some sort of consensus will be reached. Note that this consensus will be made not by free market, doctors or hospitals, but by the politicians.

Right now, the axe is swinging back... Are you sure you want to stick your neck in and enter medicine when it will start swinging forward? Think about it.

 

[Path or bust]

From $63 in 1992 to $42 in 2006 looks like a decrease to me and I will continue to say so. Of course you are a great entrepeneur and you will most assuredly buy the hospital's laboratory at the hospital at which you work so that you can then bill and collect for the technical component instead of the hospital. Of course out of that technical reimbursement you will purchase and maintain your tissue processors and pay your histotechs and buy your supplies and cassettes and slides, etc. Unless of course you plan to do all the embedding and cutting yourself and will not have any histotechs at your lab.

****Alright Alright: I think we are saying the same thing (but you are concentrating on the weak reimbursement for professional component, which afterall is what most pathologists take home). I'm just playing devil's advocate. i do appreciate that you keep us apprised of these situations and give us the perspective of a practicing pathologist. I definitely think that you're right in that things are not getting better and will probably get worse. What can I say, I love debating on these issues. But I tend to bring out the anger in people 😀.


What the hell is McFly by the way?

 

[exPCM]

See links:
http://www.g2reports.com/issues/advisory/advisory/joe_plandowski/189-1.html
http://www.g2reports.com/issues/advisory/advisory/joe_plandowski/300-1.html
http://www.g2reports.com/issues/advisory/advisory/joe_plandowski/227-1.html

It shows professional fees continuing their painfully slow but steady drop over the last 10 years. Meanwhile, associated technical fees have been on a continuous and steady march upward during much of the same time period, although the slowing of technical fee growth is now evident.

The winners and losers in this picture can be generally defined. Winners are pathologists with their own independent laboratory who have an opportunity to bill global fees, both technical and professional. Losers are hospital-based pathologists who can only bill professional fees.

Although now of course this CMS program will take away the ability of hospital based pathologists to bill for their professional (Part B) fees on hospitalized Medicare patients. Of course private insurance companies and Medicaid will likely follow suit as their track records show.

Yes, I know that real estate prices never go down and that pathologists will always be well paid.

 

[exPCM]

****Alright Alright: I think we are saying the same thing (but you are concentrating on the weak reimbursement for professional component, which afterall is what most pathologists take home). I'm just playing devil's advocate. i do appreciate that you keep us apprised of these situations and give us the perspective of a practicing pathologist. I definitely think that you're right in that things are not getting better and will probably get worse. What can I say, I love debating on these issues. But I tend to bring out the anger in people 😀.


What the hell is McFly by the way?

Path or Bust: I wish you the best in medical school, residency, and in your future career as a pathologist. I also hope to continue to see your posts here.

FYI, McFly refers to the George McFly character in the movie "Back to the Future".

 

[djmd]

Center for Medicare and Medicaid Services announced pilot programs which will bundled payments for clinicians and hospital services.

http://www.kaisernetwork.org/DAILY_REPORTS/rep_index.cfm?DR_ID=52221

Think about it.

Ok I will start thinking about it...

Oh wait we already were...

http://forums.studentdoctor.net/showthread.php?t=524840

Yaah, merge?

 

[yaah]

Merged.

In regards to McFly, I think you're referencing this

http://youtube.com/watch?v=Q5XGXRvbOY4

 

[Path or bust]

Merged.

In regards to McFly, I think you're referencing this

http://youtube.com/watch?v=Q5XGXRvbOY4

bwuahahahaaa! Thanks, I always need those visual analogies.

But seriously, people, seriously past our times

 

[LADoc00]

this would bring unheralded disaster.

No joke. This could be more epic than anyone has ever imagined.

 

[exPCM]

this would bring unheralded disaster.

No joke. This could be more epic than anyone has ever imagined.

As usual I agree with LADOC.
I have been talking to my local surgeons and many are already talking about trying to move as many surgeries as they can to outpatient surgery centers to avoid having to try and haggle and fight with a hospital for reimbursement.
I have verified with an orthopedic surgery friend that TKA and THA are 2 of the ortho procedures for which Part B payment is being eliminated in this program. So in those 4 states the hospital based pathologists will not be seeing Part B reimbusement for their hip and knee specimens beginning January 1.
I am mystified at the CAP. They appear to be asleep at the switch on this issue for the time being.

 

[LADoc00]

As usual I agree with LADOC.
I have been talking to my local surgeons and many are already talking about trying to move as many surgeries as they can to outpatient surgery centers to avoid having to try and haggle and fight with a hospital for reimbursement.
I have verified with an orthopedic surgery friend that TKA and THA are 2 of the ortho procedures for which Part B payment is being eliminated in this program. So in those 4 states the hospital based pathologists will not be seeing Part B reimbusement for their hip and knee specimens beginning January 1.
I am mystified at the CAP. They appear to be asleep at the switch on this issue for the time being.

yeah IF and I doubt it will, does happen, almost all surgeons and gas will move to MD owned speciality hospitals.

 

[exPCM]

yeah IF and I doubt it will, does happen, almost all surgeons and gas will move to MD owned speciality hospitals.

I hope that this program can be stopped. I think that this would have the same effect on anatomic pathology as the 1982 TEFRA legislation had on clinical pathology.

 

[Whiskeyjack]

Concerning the general decline of medicine. Check this recent article out. Its pretty lengthy be warned but you can skim through and get the general gist.
http://www.modernmedicine.com/moder...Article/detail/515481?contextCategoryId=41915

I mean WTF. Are doctors to be completely sidelined. Why bother training us in the first place? It seems our role is becoming limited to bearing the brunt of the liability if these quasi-medics eff-up.